The Way Forward

Howdy

Howdy getting his check up, sans sedation.  He was such a good man it was not necessary.  Side note, do not take a picture with your camera accidently in auto flash mode in a room darkened for ophthalmic exam.  You will instantly become “that owner.”  When it was firing up to flash I was like, “Noooooooo!’  An immediate mea culpa and a promise not to do it again and I was forgiven.  Thank you good people.

Howdy’s ophthalmic exam yesterday, a follow up to his ERU diagnosis, yielded excellent results.  Everything is stable and there is no inflammation in either eye.  This is really, really good.  However, it could just be the time between bouts of uveitis.  It is too early since diagnosis to say.  But there may be some reason to believe that the gentamicin and the enrofloxacin are doing their work.

There is much to consider.
Yes, I do think about doing the cyclosporin implants, but when I first read about them, they seemed to me to not be addressing the problem, but rather the symptoms.  I thought this because the research I had read indicated that ERU is an autoimmune(AI) disease which stems from the gut.  With that in mind, the cyclosporin implants seemed to be stopping the intruders at the bedroom door rather than meeting them at the end of the driveway.  In the case of it being a systemic AI response, getting the gut stabilized would be meeting trouble at the end of the driveway.
Through further learning, it is clear to me that researchers are not in agreement regarding whether the AI response is systemic (the gut) and travels to the eye or has its genesis in the eye.  There is good research on both sides of the theory, and it may be that there are several kinds of ERU (or maybe even separate diseases that present like ERU, but that we haven’t discerned as separate yet) that have different disease courses.  If in the eye, then the cyclosporin implants would be the way to go.  If in the gut, then pre- and probiotics would seem to be indicated, as a change in the gut flora has shown to be palliative or curative in some human AI diseases.  And the problem could be in both places, of course.
I learned yesterday that Howdy’s lepto titer in his eye fluid was still discernible at a dilution of 1:1600, which implies a very high titer indeed.  He had no lepto titer in his blood serum.  This was interpreted as good news by optho vet yesterday.  I need to talk to her to find out if they are testing for the presence of the organism or the response to the organism.  My nightmare scenario would be that treating with the antibiotics does not stop the disease process because the disease is an AI over-reaction to an organism that no longer exists in the eye.  BUT, Howdy’s eyes were much improved at his exam yesterday, which may be a result of the gentamicin eye injection or, when I consider it brutally honestly, could just be a space between uveitis attacks.  This is a realistic thought, but not one that I allow to set up camp and invite its friends over to party in the center of my thought process.  “Yes, I heard you, now run along.”  There is no need to baste myself in fear.
I do not always know which way to go, but I am going forward in confidence that if I keep moving, a way will be shown to me through both science and the prayers I send up in faith and joy.
For the moment, we are going to proceed with the enrofloxacin protocol which takes a month.  During that time, I will be giving him periodic pre- and pro- biotics to support his immune system and to replace any beneficial microbial populations that may be experiencing collateral damage from the systemic antibiotic enrofloxacin (and also continue riding him and showing him cows, LOL).
It is a little unusual, but I would like to have another intra-vitreal fluid draw when he goes in for a check up in a month to see what his eye titer is at that time.  That procedure carries some risk and most people don’t do it, but I think the risk is worth the value in knowing what is going on.  We shall see what the ophthalmologists think of that plan.  Then, the best decision in how to proceed can be made at that time.
Meanwhile, his eye looks great this morning and he is out eating grass like a boss.
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